The Management of Membranous Glomerulopathy in Allogeneic Stem Cells Transplantation: Updated Literature

Author(s): Pasquale Niscola, Andrea Tendas, Xiao-dan Luo, Gianfranco Catalano, Laura Scaramucci, Luca Cupelli, Marco Giovannini, Michele Ferranini, Francesco Bondanini, Daniela Piccioni, Teresa Dentamaro, Roberto Palumbo, Alessio Pio Perrotti, Qi-fa Liu, Paolo de Fabritiis.

Journal Name: Cardiovascular & Hematological Agents in Medicinal Chemistry

Volume 11 , Issue 1 , 2013

Abstract:

Background: membranous glomerulopathy (MG) is an immunomediated disorder which accounts for the most common cause of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (HSCT).

Objective and Methods: to provide an update on the issue by reviewing pertinent literature on the MEDLINE database.

Results: sixty-nine post allogenic HSCT patients (42 male) with MG were identified. The median age was 43 (5 to 68) years. Time interval from allogenic HSCT to MG diagnosis ranged from 3 to 134 months (median 17). Most MG patients had a history of acute (70%) or chronic (84%) graft versus host disease (GVHD). Corticosteroids and cyclosporine were the most common therapeutic agents used in this setting; alternative therapies, including rituximab, were given to a lower number of patients. Outcome data were available in 64 out of 69 MG patients; 38 (59%) and 18 (28%) patients achieved a complete and a partial response respectively, whereas treatment failure was recorded in the remaining 8 (13%).

Conclusion: MG after allogenic HSCT appears to be associated with a sub clinical or overt cGVHD, which follows the discontinuation of immunosuppressive prophylaxis. Although a standard therapeutic approach has not been established, the application of available measures can induce favorable response in more than 80% of affected patients, but treatmentfailure and progressive deterioration of the renal function may occur in about one fifth of cases.

Keywords: Allogeneic hematopoietic stem cell transplantation, chemotherapy, conditioning regimen, corticostroids, cyclosporine, glomerulonephritis, graft-versus-host disease, leukemia, lymphoma, membranous glomerulopathy, multiple myeloma, nephrotic syndrome, radiotherapy, renal failure, rituximab

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Article Details

VOLUME: 11
ISSUE: 1
Year: 2013
Page: [67 - 76]
Pages: 10
DOI: 10.2174/1871525711311010011

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